cervical cancer

DePinho, who’s been a cancer researcher for decades and currently serves as the president of the University of Texas MD Anderson Cancer Center, wants to reframe the national conversation about the HPV vaccine to drive home a fundamental point.

“It’s important to appreciate that this is a cancer vaccine. A cancer vaccine!” DePinho said in an interview with ThinkProgress. “It’s a dream come true that we’ve converted knowledge into something that can actually save lives and avoid getting cancer in the first place. It’s really what we have been hoping for, and now we have it.”Since the introduction of the HPV vaccine in 2006, the rate of human papillomavirus in teenage girls has plummeted. And the research in this field continues to advance. On Thursday, the Food and Drug Administration approved an updated version of the Gardasil vaccine that protects against nine strains of the cancer-causing virus — more than twice as many as the 2006 version, which covered just four strains.

According to DePinho, that’s a really significant advance for cancer care. He doesn’t want it to get lost in the ongoing controversy about HPV vaccination, a round of shots that some parents still worry is unsafe or inappropriate for their kids.There’s a persistent myth, for instance, that giving teen girls the shots will spur them to become more “promiscuous” because they know they’ll be protected from a sexually transmitted infection. Large scientific studies have debunked the notion that there’s any link between the HPV vaccine and sexual activity, but inoculation rates still lag behind in some of the Southern states that are wary to provide teens with preventative tools to protect their sexual health.In general, HPV vaccination rates in the U.S. are still much too low, hovering around 30 percent. Public health professionals are aiming to increase those rates dramatically, to at least 80 percent — closer to the percentage of people who get vaccinated against the virus in other developed countries.

To accomplish that, the health professionals who have dedicated their lives to treating HPV-related cancers want to move the conversation away from sexuality altogether. Instead of framing Gardasil as vaccine that protects against an STD — which might give some Americans the impression that they don’t need to worry about it — they want to present it as a vaccine that protects against cancer.

“It doesn’t seem like it makes sense to see it in terms of a vaccine for a sexually transmitted disease necessarily,” Dr. Erich Sturgis, an expert in head and throat cancer who works as the program director for the MD Anderson Oropharynx Program, said in an interview with ThinkProgress. “Most of us will have an HPV infection at some point in our lifetime and we’ll never know it.”Nearly all sexually active Americans get HPV at some point in their lives, according to the Centers for Disease Control and Prevention. An estimated 80 percent of people are infected at some point, and most never realize it because the infection resolves itself on its own. But certain strains of the virus go on to cause cervical, vulvar, anal, penile, and oropharyngeal cancers.

Without the HPV vaccine, men in particular are put at risk of developing neck and throat cancers. Unlike cervical cancers, which can be detected with regular Pap smears, there’s no way to screen men.

Sturgis treats mostly middle aged male patients, and he estimated that about 60 percent of the cancers he deals with are caused by HPV. He said it’s important to increase the rates of vaccination among both girls and boys because it will be another 30 to 40 years before today’s kids hit the point when these type of throat cancers may start displaying themselves.“To let your kids potentially suffer later in life is just a tragedy. That’s really the message here,” he said.

Both cancer doctors are optimistic that once more parents are educated about what’s at stake, they’ll start vaccinating their kids at higher rates. There’s a big information gap — one recent study found that 70 percent of U.S. adults didn’t realize the HPV vaccine has any connection to cancer whatsoever — that they believe can be corrected with more investment from primary care doctors who are on the front lines of recommending the shots.

“It’s really about empowering parents and health care professionals, and making them recognize that this is a childcare responsibility and a priority for all of us,” DePinho said. “It begins with interviews like this and just having the media getting this information out there.”

“Doctors are probably not as good at messaging to the public as we could be. We need some help,” Sturgis agreed.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Public-health officials are pushing for higher HPV vaccination rates amid growing evidence that cancers linked to the virus are afflicting more men.

The National Cancer Institute announced recently it is pouring nearly $2.7 million into 18 U.S. cancer centers to boost HPV vaccinations among boys and girls. The cancer centers will work with local health clinics to set recommendations for vaccinating against the sexually transmitted infection, which in some cases can cause cancers in men and women later in life.

HPV, or human papillomavirus, was considered a women’s-only issue, after researchers discovered a link between it and cervical cancer in the 1980s.

Now, as cervical-cancer rates are falling and oral-cancer rates in men steadily rise, “the burden of HPV cancer is shifting to men,” said Maura Gillison, a professor in the College of Medicine at Ohio State University Comprehensive Cancer Center.

The Department of Health and Human Services’ goal is to boost HPV-vaccination rates to 80% by 2020—which is far higher than the 38% of girls and 14% of boys who completed the three-dose HPV vaccine last year, according to data from the National Immunization Survey of teenagers.

Pediatricians say boosting those rates can be difficult. Pediatricians may feel uneasy talking to parents of young children about sexually transmitted infections, health experts say, while parents may resist the vaccine because they believe their child isn’t at risk.

“Discussing this vaccination is difficult because there’s an implication of sexual activity,” said Carrie Byington, a practicing pediatrician in Salt Lake City and chairwoman of the Committee on Infectious Diseases for the American Academy of Pediatrics. “It can make some pediatricians uncomfortable with the topic.”

A study conducted in 2011 by the Moffitt Cancer Center in Tampa, Fla., found fewer than 15% of physicians always recommended the vaccine to boys, and no more than 55% always recommended it to girls. Susan Vadaparampil, a professor in the department of oncologic services at Moffitt who helped lead the study, said she thinks recommendation rates have risen today but there’s a long way to go.

To ease difficult conversations, Dr. Vadaparampil said resources on the Centers for Disease Control and Prevention website suggests that pediatricians should emphasize the vaccine is ultimately a protection against cancer and explain why children should receive the shots at such a young age.

Experts recommend the vaccine at age 11 or 12, but it can be given to girls up to age 26 and boys up to age 21. It is important for children to receive all three doses of the vaccine before they become sexually active.

“There’s science behind giving it at age 11—it’s not just about moral or family choices, or a child’s choice for sexual debut,” said Wendy Sue Swanson, a pediatrician and executive director of digital health at Seattle Children’s Hospital. “The immune response is better if you give it to an 11-year-old.”

Administering the vaccine at a young age doesn’t encourage sexual activity, Dr. Swanson said, citing a concern some parents have. A 2012 study comparing girls who had been vaccinated at ages 11 and 12 to nonvaccinated girls showed the vaccine made no difference in sexual behavior for at least three years after receiving the doses.

Not all cases of HPV are cancerous. Experts estimate nearly 79 million Americans are currently infected with one of the 100 different strains of HPV, which is passed via sex.

Typically, a body’s immune system fights off HPV naturally within two years of exposure. Complications, such as genital warts or cancer, arise when the virus lingers.

About 26,800 Americans are diagnosed with HPV-related cancers each year, about two-thirds of whom are women, according to 2010 data, the latest available, from the CDC.

The largest HPV-related threat to men is throat cancer, which has grown sharply in the past decade, Dr. Gillison said.

Today, more than 90% of all oral cancers are HPV-related, according to trends Dr. Gillison has observed in clinical settings in developed countries. That is up from about 72% between 2000 and 2004 and 16% between 1984 and 1989, she said, referencing a study she conducted that analyzed throat tumors in the U.S.

Most of that growth has been in men: Each year, about 7,200 American men are diagnosed with HPV-related oral cancer, versus 1,800 cases in women, according to 2010 CDC data.

Dr. Gillison said researchers estimate that around 2020, HPV-related oral cancers in men will eclipse cervical cancer, which afflicts some 12,000 new women each year, according to 2014 data from the American Cancer Society.

It’s unclear why men are more at risk for oral cancer than women, though some researchers suggest a person’s number of sexual partners may be related. The rise is problematic, Dr. Gillison said, because no preventive screening against throat cancer exists.

“The problem with HPV-positive oral cancer is that premalignant lesions are not clinically detectable. They’re deep within the tonsils that are in the base of the tongue,” Dr. Gillison said. “By the time HPV-infection is detected, they usually already have Stage 3 or 4 cancer.”

That is why doctors and experts are relying so heavily on vaccination as prevention.

Two vaccines—Cervarix, manufactured by GlaxoSmithKline Inc., and Gardasil, manufactured by Merck & Co.—are currently available, though only Gardasil is usually recommended for boys.

Cervarix offers protection against two strains of HPV; Gardasil against four. A third vaccination from Merck currently awaiting approval from the Food and Drug Administration would offer protection against an additional five strains of HPV—nine in total. Doctors expect approval within in the next several months.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

An international coalition of cancer specialists led by a researcher now at Baylor College of Medicine has identified an immune related gene called transforming growth factor beta receptor 1 (TGFBR1) that appears to play an important role in determining whether a person develops a cancer related to human papilloma virus (HPV). HPV is, in particular, associated with anal cancer and cancers of the cervix, and the head and neck.

Their findings appear in the journal Cancer Research.

Until recently, head and neck cancer has been found primarily in smokers, but there has been a rise in HPV-associated head and neck cancer in nonsmokers. The head and neck cancer most-associated with HPV is oropharyngeal cancer, involving the tonsils and base of the tongue.

HPV is also one of the most common sexually transmitted diseases, with certain strains known to cause head and neck and/or cervical cancer.

The National Cancer Institute predicts that HPV-positive oropharyngeal cancer will likely surpass cervical cancer as the most common HPV-associated cancer in the United States by 2020.

“The real mystery is that in western countries, pretty much everyone is exposed to HPV but only a small number of people get HPV-related cancers,” said Dr. Andrew Sikora, vice-chair for research in the Department of Otolaryngology Head and Neck Surgery at Baylor. “We are trying to figure out what makes the people who actually get the cancer different from those who don’t, given that so many people are exposed.”

Using data collected as part of a genome-wide association study of head and neck cancer performed by the INHANCE consortium, the researchers were able to associate alterations in a number of immune-related genes with oropharyngeal cancer. One of these genes, TGFBR1, was found to be deregulated in patients with both oropharyngeal and cervical cancer.

“The fact that we were able to independently replicate our findings in two-different HPV-related cancers is exciting because it suggests that we have found something that is critical to the biology of how HPV causes cancer,” said Sikora, also co-director of the head and neck cancer program in the NCI-designated Dan L. Duncan Cancer Center Baylor.

“We hope to learn more about this gene and how it affects cancer,” Sikora added. “In the future we hope to develop a tool to identify who is more susceptible to HPV-related cancers.”

Sikora conducted the study while on faculty at the Icahn School of Medicine at Mount Sinai in New York prior to joining the Baylor faculty in July 2014. Co-author, Paolo Boffetta, director of the Institute for Translational Epidemiology at ISMMS was one of the investigators for the original INHANCE study.

Others who took part in this study include: Chaya Levovitz; John Finnigan; Sara Alshawish; Marshal R. Posner; Weija Zhang; Eric E. Schadt; Eric M. Genden and Paolo Bofetta; The Icahn School of Medicine at Mount Sinai in New York; Dan Chen and Emma Ivansson of Uppsala University, Uppsala, Sweden.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Not so long ago, when my sons still had smooth cheeks and children’s voices, I had them vaccinated against human papillomavirus, the most common sexually transmitted disease. It was late 2011, and the Centers for Disease Control and Prevention had just recommended that boys join girls in being vaccinated at age 11 or 12. I was certainly receptive: HPV, as it’s commonly called, causes cervical cancer, cancer of the tonsils, cancer of the back of the tongue and, less often, cancers of the vulva, vagina, anus and penis. It seemed important to ensure that my kids were protected.

Yet numbers released last month by the CDC show that my sons, now 14 and 15, are among a small minority of adolescent males who have been vaccinated. In 2013, just 14 percent of American boys ages 13 to 17 had received all three recommended doses of the HPV vaccine. (The CDC also recommends “catch-up” vaccination for males up to age 21.)

Not that parents are rushing to have their girls vaccinated either, even though the CDC first recommended the vaccine for prepubescent girls in 2007 and virtually all insurers pay for it. In 2013, fewer than 38 percent of American girls between 13 and 17 had received the full three-dose course.

It is heartbreaking to watch a safe, effective vaccine go unused. Consider this: The CDC estimates that increasing the vaccination rate of American girls to 80 percent would prevent 53,000 cervical cancers during the lifetimes of girls who are now 12 and younger.

When I had my sons vaccinated, it was partly with girls in mind. After all, if fewer young men are infected, fewer young women will be exposed to the virus that causes cervical cancer — currently the most common cancer prevented by the vaccine. But now I am realizing that HPV poses a growing risk to boys.

A new breed of cancer of the back of the tongue and tonsils, caused by HPV, is rising in incidence — likely caused, researchers suspect, by increases in premarital sex and oral sex over the past several decades. These cancers afflict men far more often than women, and at relatively younger ages than do other head and neck cancers, which typically appear in men older than 60. Middle-aged men who don’t die from their HPV-linked cancer often must live for years with the side effects of intensive chemotherapy and radiation delivered to the back of the throat. These can include the permanent inability to swallow and the appearance later ofnew, aggressive, radiation-induced cancers.

If this trend continues, we are going to see more cancer of the back of the tongue and the tonsils caused by HPV. One recent analysis of 30 studies, conducted by University of Wisconsin researchers, found that the proportion of such cancers caused by HPV rose from 21 percent before 1990 to 65 percent after 2000. Anil Chaturvedi of the National Cancer Institute and his colleagues have estimated, based on recent trends, that by 2020 there will be more new cases of these HPV-induced throat cancers in the United States each year than new cervical cancer cases.

So the actor Michael Douglas did us all a service when he was so frank with Britain’s Guardian newspaper last year. When asked if his throat cancer had been caused by heavy drinking and smoking, which are also risk factors for the disease, the actor replied: “No. I mean, without getting too specific, this particular cancer in tests is caused by something called HPV, which actually comes about from cunnilingus.”

Many parents don’t like to think of their 11- and 12-year-olds as sexual creatures. Ironically, the CDC recommendation assumes not that kids are sexually active at this tender age but rather that they are not: The point of vaccination is to close the door before the horse is out of the barn.

It’s no use telling yourself that your child isn’t “that kind” of kid. The fact is, HPV is so common that almost all sexually active adults are infected at some point. Last year, the CDC estimated that about 79 million Americans were infected, most of them in their late teens and early 20s.

Most people who get HPV have a transient infection that their immune system clears with no lasting damage. But in some people, the virus takes up residence and goes on to cause cancer. I am grateful that, thanks to the HPV vaccine, I will never have to find out if my sons fell into that second, unlucky group.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

August 14, 2014 — Researchers have hijacked a defense system normally used by bacteria to fend off viral infections and redirected it against human papillomavirus (HPV), the virus that causes cervical, head and neck, and other cancers, according to a new study in the Journal of Virology (August, 6, 2014).

Using a genome editing tool, researchers from Duke University were able to selectively destroy two viral genes responsible for the growth and survival of cervical carcinoma cells, causing the cancer cells to self-destruct.

The study findings validate an approach only recently attempted in mammalian cells, and they could help in the development of antiviral strategies against other DNA-based viruses such as hepatitis B and herpes simplex.

“Because this approach is only going after viral genes, there should be no off-target effects on normal cells,” said senior study author Bryan R. Cullen, PhD, a professor of molecular genetics and microbiology at the Duke University School of Medicine, in a statement. “You can think of this as targeting a missile that will destroy a certain target. You put in a code that tells the missile exactly what to hit, and it will only hit that, and it won’t hit anything else because it doesn’t have the code for another target.”

When examining the genomes of different types of bacteria, researchers noted long stretches where the same genetic sequence was repeated. But in between these repeated stretches were DNA sequences that varied from bacteria to bacteria. About a decade ago, researchers determined that these varied sequences, clustered regularly interspaced short palindromic repeats (CRISPR), were derived from viruses that had infected the bacteria.

When bacteria are infected, a small portion of the offending viral DNA is copied and placed between the repeat elements for future reference. When the bacteria come into contact with that virus again, it has a “memory” of it, which activates the bacterial protein Cas9, which destroys any recognized offenders before they can hurt the bacteria again.

The CRISPR system is now being repurposed by researchers for many purposes, including introducing mutations for study or to repair genetic defects.

In the current study, Cullen decided to target HPV. Specifically, he and his colleagues went after two oncogenes that block the host’s efforts to keep cancer cells at bay, viral genes E6 and E7.

To accomplish this, the researchers needed the target code for E6 or E7, consisting of a short strip of RNA sequence, and the Cas9 protein, which would cut any DNA that could line up and bind to that RNA sequence.

They packed the antiviral concoction into a viral vector based on a disabled version of HIV and infected cervical carcinoma cells in a lab dish with this genetically engineered virus. Researchers then assessed whether it could effectively destroy HPV infection and block cancer cell growth.

The carcinoma cells that received the anti-HPV guide RNA/Cas9 combination immediately stopped growing. In contrast, cells that had received a control virus, containing a random guide RNA sequence, continued to grow.

The researchers then looked at the consequences of destroying E6 or E7 in cancer cells. E6 normally blocks protein p53, which activates the so-called “suicide” pathways in a cell when it senses that something has gone wrong. In this study, targeting E6 enabled p53 to resume its normal function, causing the death of the cancer cell.

E7 works in a similar way, blocking a protein called retinoblastoma (Rb) that can trigger growth arrest and senescence, another form of cell death. As expected, the researchers found that targeting E7 also set this second tumor suppressor back in motion.

“As soon as you turn off E6 or E7, the host defense mechanisms are allowed to come back on again, because they have been there this whole time, but they have been turned off by HPV,” Cullen said. “What happens is the cell immediately commits suicide.”

Cullen and his colleagues are now working on developing a viral vector based on the adeno-associated virus, to deliver their CRISPR load into cancer cells. Tests in animal models will follow once that is in place

“What we would hope to see in an HPV-induced cancer is rapid induction of tumor necrosis caused by loss of E6 or E7,” Cullen said. “This method has the potential to be a single-hit treatment that will dramatically reduce tumor load without having any effect on normal cells.”

The researchers are also targeting other viruses that use DNA as their genetic material, including the hepatitis B virus and herpes simplex virus.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Although there has been a slight increase in human papillomavirus vaccination coverage among adolescents since 2012, a new report from the Centers for Disease Control and Prevention states that vaccine coverage in this population remains “unacceptably low”.

Human papillomavirus (HPV) is the most common sexually transmitted infection in the US. There are more than 150 types of HPV, 40 of which can be contracted through skin-to-skin contact during vaginal, anal or oral sex.

Low-risk HPV types, such as HPV-6 and HPV-11, can cause warts around the genitals or anus. But high-risk types, including HPV-16 and HPV-18, account for approximately 5% of all cancers worldwide.

Specifically, HPV-16 and HPV-18 account for around 70% of all cervical cancers and almost 50% of all vaginal, vulvar and penile cancers. HPV-16 is also accountable for more than 50% of throat cancers.

There are currently two vaccines available for HPV, which are administered in three shots over 6 months. Cervarix and Gardasil are used for the prevention of cervical cancer, while Gardasil can also protect against anal, vulvar andvaginal cancers and genital warts.

The Advisory Committee on Immunization Practices (ACIP) recommends that preteen girls and boys aged 11 or 12 are vaccinated against HPV. The vaccination is also recommended for teenage girls and young women up to the age of 26 who did not receive it when they were younger, and teenage boys and young men up to the age of 21.

HPV vaccination coverage increased in 2012-13, but remains too low

But despite these recommendations, a new report from the Centers for Disease Control and Prevention (CDC) – published in this week’s Morbidity and Mortality Weekly Report – estimates that in 2013, only 57% of girls and 35% of boys ages 13-17 years received one or more doses of the HPV vaccine.

The figures came from results of the CDC’s National Immunization Survey-Teen (NIS-Teen), which includes vaccine information via telephone surveys for adolescents aged 13-17 years from across the US.

The CDC investigators did, however, find that HPV vaccination coverage increased slightly among girls between 2012-13, from 53.8% to 57.3%, although only a third received the complete three doses. Teenage boys saw a greater increase in vaccination coverage, from 20.8% to 34.6%.

But still, the CDC say HPV vaccination coverage among adolescents is too low, particularly when compared with coverage to other vaccination types. For example, another report from the CDC found that almost 86% of adolescents received one dose of the Tdap vaccine last year, which protects against tetanus, diphtheria and whooping cough.

A 10-year national objective in the US – set in 2010 by Healthy People 2020 – is to reach 80% HPV vaccination coverage among adolescents. These latest statistics suggest there is a lot of work to be done. But lead author of the report, Shannon Stokley, assistant director for science at the CDC’s Immunization Services Division, says they also show the 80% vaccination coverage target is realistic:

“The data on missed vaccination opportunities tells us that it is possible. When we look at the most recent cohort of girls that turned 13, 91% of them had a health care encounter where they could have started the HPV vaccine series before their 13th birthday.

Also, 86% of 13-17 year-olds have received the Tdap vaccine. What these numbers tell us is that preteens and teens are getting to the doctor and they are getting vaccinated, but they aren’t always receiving the HPV vaccine.”

Why is HPV vaccination coverage still low?

From NIS-Teen, the CDC investigators were also able to establish some reasons as to why HPV vaccination coverage remains low among adolescents.

They found that clinicians’ recommendations significantly influenced a parent’s decision of whether to have their children vaccinated against HPV.

Of parents whose daughters were vaccinated, 74% said they received a recommendation from their doctor, while 52% of parents who did not have their daughters vaccinated received a doctor’s recommendation. Among parents whose sons were vaccinated, 72% received a recommendation, while only 26% of parents whose sons were not vaccinated received a recommendation.

Based on these findings, Dr. Anne Schuchat, assistant surgeon general and director of CDC’s National Center for Immunization and Respiratory Diseases, believes health care professionals are key in boosting HPV vaccination coverage among adolescents in the US.

“Pediatricians and family physicians are uniquely situated to prevent missed opportunities by giving HPV vaccine during the same visit they give Tdap and meningococcal vaccines,” she adds.

Parents also revealed that concerns over the safety of the HPV vaccine deterred them from vaccinating their children. However, the CDC stress that – after analyzing national postlicensure vaccine safety data – no serious safety concerns have been linked to the HPV vaccine in the 8 years it has been available.

The investigators point out that the most commonly reported side effects of the vaccine include dizziness, fainting, nausea and headache, and injection-site reactions – including pain, redness and swelling.

When we asked Stokely what needs to be done to alleviate parents’ concerns about vaccinating their children against HPV, she replied:

“Parents need to see information in mainstream media that HPV vaccination is very effective at preventing infection with the types of HPV that cause the most cancers. Parents also need to hear that the HPV vaccine is safe and that it is recommended to be given when their children are 11 or 12 years old, before their risk of acquiring an HPV infection increases.”

In conclusion to the report, the CDC say they will continue efforts to team up with state and local immunization programs, cancer organizations, professional organizations and other stakeholders in an attempt to educate parents and health care professionals about the importance of the HPV vaccine, adding:

“Collaborative efforts remain critical to promoting HPV vaccination so that the nation’s adolescents are protected against vaccine-preventable, HPV-associated cancers.”

Earlier this year, Medical News Today reported on a study claiming that two thirds of healthy American adults areinfected with one or more of 109 strains of HPV.

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

More than two thirds of healthy US residents harbor at least 1 type of human papillomavirus (HPV), most of which are undetectable by widely used commercial screening kits, a large genetic analysis shows. However, the relevance of this is at present unclear, commented an expert not connected with the study.

The study identified 109 different HPV types in tissue samples taken from 103 men and women whose tissue DNA was made available through the National Institutes of Health (NIH) Human Microbiome Project.

Only 4 individuals carried either HPV 16 or 18, considered to be among the most oncogenic HPV types and associated in particular with cervical cancer.

“There are more than 170 HPV types, so it’s a very heterogeneous virus, and current methods only detect about 20 to 30 of them,” senior investigator Zhiheng Pei, MD, PhD, associate professor of pathology, New York University School of Medicine, in New York City, told Medscape Medical News.

“[Because] non-risk or low-risk HPV types have been very understudied, we would like to see if these non-cancer-causing HPV types play a role in cancers other than cervical cancer or, conversely, if HPV infection is in fact beneficial in an asymptomatic population,” Dr. Pei commented.

The study was presented at the annual meeting of the American Society for Microbiology in Boston, Massachusetts.

Shotgun Sequencing

For the study, researchers decoded DNA assembled by a technique called shotgun sequencing.

In this method, researchers fragment long DNA strands into short fragments and then randomly sequence each small fragment, as Dr. Pei explained.

In all, DNA from 748 tissue swabs was analyzed. Tissue was taken from multiple organ sites, including the skin, vagina, mouth, and gut. Tissue was collected in 2009 at a time when HPV vaccination was not popular, as Dr. Pei observed.

All human DNA was removed, and HPV DNA was matched to an HPV reference genomic database.

This allowed researchers to see the entire community of HPV types in a healthy segment of the population.

The highest prevalence of HPV infection was found on the skin, at 61.3%. This was followed by the vagina, with a prevalence of 41.5%; the mouth, at 30%; and the gut, at 17.3%.

Multiple HPV types were also detected in 48.1% of all HPV-positive samples.

“Our study offers initial and broad evidence of a seemingly ‘normal’ HPV viral biome in people that does not necessarily cause disease and that could very well mimic the highly varied bacterial environment in the body, or microbiome, which is key to maintaining good health,” Dr. Pei said in a press release.

As researchers suggest, the overwhelming presence of so many HPV viral strains in a normal, healthy viral biome may be an indication that certain viral strains could be keeping each other in check so that other strains do not spread out of control.

On the other hand, more and more studies are identifying HPV-related cancers in body sites other than the uterine cervix, as Dr. Pei noted. In particular, there has been an increase in HPV- related oropharyngeal cancers in recent years.

It therefore could be that the so-called low-risk or nononcogenic HPV types could actually be implicated in cancers at these different sites, including oral cancer, oropharyngeal cancer, and skin cancer.

“Right now, we certainly don’t know what this high prevalence of HPV infection means in a healthy population, and more investigations are needed to understand the impact of asymptomatic HPV infection on human health,” Dr. Pei told Medscape Medical News.

“So we need to see the complete picture of HPV infection, and eventually, we will know what this high HPV prevalence means, and we can then perhaps suggest some additional HPV types that should be included in the clinical detection kit to broaden HPV detection.”

Relevance to Human Disease Is Unclear

Asked to comment on the study, Maura Gillison, MD, PhD, professor and Jeg Coughlin chair of cancer research at the Ohio State University, in Columbus, Ohio, told Medscape Medical News that it is difficult to tell to what extent the sample of only 103 individuals represents the US population as a whole.

“Based on the older methods capable of detecting 37 HPV types, the CDC [US Centers for Disease Control and Prevention] estimated that ~42.5% of US women have a cervical HPV infection at any point in time,” she noted, adding that it is “perhaps surprising” that with shotgun sequencing, only 42% of women in the Microbiome Project sample had a vaginal infection.

“I would think the estimates would be more dramatically different from one another,” Dr. Gillison added.

She concurred with investigators that although the study is interesting, “at this time, it’s of unclear relevance to human disease.”

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

The USA is failing to protect children from preventable cancers that afflict 22,000 Americans a year by not vaccinating enough of them against HPV, a new report says.

Although a safe and effective HPV vaccine has been available for eight years, only one-third of girls have been fully immunized with all three recommended doses, according to a report from the President’s Cancer Panel, which has advised the White House on cancer since 1971. HPV, or human papillomavirus, is a family of viruses that causes cancer throughout the body, including cancers that predominantly affect men, such as a type of throat cancer. Only 7% of boys are fully vaccinated, although the Centers for Disease Control and Prevention has recommended the shots for them since 2011.

Raising vaccination rates to at least 80% of teen girls could prevent 53,000 future cases of cervical cancer in girls alive today, according to the CDC.

“Our children deserve this protection,” says panel chairperson Barbara Rimer, a professor at the University of North Carolina at Chapel Hill.

Administering the HPV shot poses practical difficulties not faced by other adolescent vaccines, because it currently requires three doses, at least two months apart, beginning when kids are 11 or 12, says pediatrician Mary Anne Jackson, director of infectious diseases at Children’s Mercy Hospital & Clinics in Kansas City, Mo., who wasn’t involved in the new report. Although emerging research suggest that two doses could be equally effective, experts have not yet changed their recommendations.

And at a total cost of $400 for three shots, the HPV vaccine is also more expensive than other vaccinations, although it’s often covered by insurance, Jackson says.

The real problem, research shows, is that doctors are treating HPV vaccinations differently than other shots recommended for kids at that age, such as meningitis and whooping cough boosters, Jackson says.

All too often, doctors offer HPV shots, giving parents the option to vaccinate, without strongly recommending them, says Debbie Saslow of the American Cancer Society, who served as an adviser on the report. That could be because doctors are leery of initiating a discussion about sexual activity, which is how HPV spreads, Saslow says. Doctors recommend giving HPV shots to kids at a young age, when they’re most effective.

Yet studies show that most parents are likely to follow their pediatrician’s recommendations, Jackson says. Most families would likely agree to HPV vaccinations if doctors simply included it in their general package of middle-school shots, Jackson says. Studies have found the vaccine to be extremely safe, with no increase in serious side effects, in spite of giving 56 million doses of the shots in the USA alone.

Future HPV vaccines may soon be even more protective than the original shot. While the current vaccines can prevent about 70% of cervical cancers, HPV vaccines under development will protect against 90% of cervical tumors, the report says.

“If we could get physicians to give a strong message about HPV vaccination to every child, we could make a real difference,” says Rimer, whose report notes that 60% of girls in the United Kingdom and 71% in Australia are fully vaccinated against HPV. “The conversation needs to be framed around cancer prevention, not about sex.”

State lawmakers could help boost vaccination rates, Rimer says, by passing laws to allow pharmacists to administer HPV shots to teens just as they do flu shots. Only 6% of pharmacists are in states that allow them to give HPV shots without prior approval from a physician.

The panel also asks President Obama to lend his support to HPV vaccination.

“Your support of widespread HPV vaccination starting today can help save thousands, and perhaps hundreds of thousands, of lives, and could forever alter the landscape for cancers related to HPV,” the report says. “No man or woman should have to suffer or die from cancer or other diseases when the means by which to prevent them is within our grasp.”

* This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.

Young women who are vaccinated against the human papillomavirus (HPV) not only protect themselves from cervical cancer, but from throat cancer as well, a new study suggests. Many of the increasing number of throat cancers, seen mostly in developed countries, are caused by HPV infection and the HPV vaccine might prevent many of these cancers, the researchers say.

“We found the women who had the HPV vaccine had much less infection than the women who hadn’t,” said lead researcher Dr. Rolando Herrero, at the International Agency for Research on Cancer in Lyon, France.

“In fact, there was a 90 percent reduction in the prevalence of HPV infection in the women who received the vaccine compared to the women who had not,” he said.

HPV infection is strongly associated with cancer of the oral cavity, Herrero noted. “We think that it is possible that the prevention of the infection will also lead to the prevention of these cancers,” he explained.

The HPV vaccine has enormous benefit, said Herrero, “because of the cervical cancer prevention and the anal cancer prevention, and it can even prevent infections in their sexual partners.”

Herrero said boys, too, should be vaccinated to protect them from oral cancers. Oral cancer is much more prevalent among men than in women, he pointed out.

A 2011 study in the Journal of Clinical Oncology showed that in the United States, HPV-positive oral cancers increased from 16 percent of all oral cancers in the 1980s to 70 percent in the early 2000s. And according to the Oral Cancer Foundation, nearly 42,000 Americans will be diagnosed with oral and throat cancer in 2013, and more than 8,000 people will die from these conditions.

HPV-linked throat cancer recently came to the public’s attention when the British newspaper The Guardian reported that actor Michael Douglas’ recent bout with the disease might have been caused by oral sex.

For the new study, Herrero’s team randomly assigned more than 7,400 women aged 18 to 25 to either receive the HPV vaccine or a vaccine against hepatitis A, as a comparison.

Women in the HPV vaccine group were given Cervarix, one of two vaccines available for HPV prevention. (The other is Gardasil.)

Four years later, the researchers found the HPV vaccine was 93 percent effective in preventing throat cancer. Among women who received the HPV vaccine, only one patient showed an oral HPV infection, compared with 15 in the hepatitis A vaccine group, the researchers found.

The HPV vaccine costs $130 a dose and because three shots are required, the total cost is about $390, according to the U.S. Centers for Disease Control and Prevention. There are government programs that can help offset these costs for some patients, the agency noted.

Because HPV is a sexually transmitted infection, the vaccine is most effective when given before someone is sexually active. Eighty percent of people will test positive for HPV infection within five years of becoming sexually active, said Dr. Marc Siegel, an associate professor of medicine at NYU Langone Medical Center, in New York City.

That’s why the CDC recommends the vaccine for adolescent girls and boys starting at age 11.

The new report was published in the July issue of the online journal PLoS One.

“The study is really preliminary information,” said Dr. Elizabeth Poynor, a gynecologic oncologist and pelvic surgeon at Lenox Hill Hospital, in New York City. “It will provide a basis to begin to study how the vaccine will help to protect against throat cancer,” she noted.

“It’s going to take a while to study those who have been vaccinated to determine that they are protected against throat cancer. This is just the beginning,” she said.

A vaccine that protects women against cervical cancer also appears to protect them against throat cancers caused by oral sex, and presumably would protect men as well, according to a study released Thursday.

Rates of this throat cancer have soared in the past 30 years, particularly among heterosexual middle-aged men. About 70 percent of oropharyngeal cancers are now caused by sexually transmitted viruses, up from 16 percent in the 1980s. The epidemic made headlines last month when the actor Michael Douglas told a British newspaper that his throat cancer had come from performing oral sex.

Oncologists have assumed that the human papillomavirus vaccine, which is used to prevent cervical cancer, would also prevent this other type of cancer, but this was the first study to provide evidence.

“This is a very nice paper,” said Dr. Marshall R. Posner, medical director for head and neck cancer at Mount Sinai Medical Center in New York, who was not involved in the study. “We expected this — that’s why we want everyone to vaccinate both boys and girls. But there’s been no proof.”

The study, supported by the National Cancer Institute, found that Cervarix, made by GlaxoSmithKline, provided 93 percent protection against infection with the two types of human papillomavirus that cause most of the cancers.

“We were surprised at how big the effect was,” said Dr. Rolando Herrero, head of prevention for the World Health Organization’s International Agency for Research on Cancer, and the study’s lead author. “It’s a very powerful vaccine.”

The study was done with 5,840 women in Costa Rica who were ages 18 to 25 and sexually active when it began. Four years after being vaccinated, each gave a mouthwash gargle sample that picked up cells from deep in the throat. Only one woman who had received the vaccine was infected with the viruses HPV 16 or HPV 18, the cancer-causing types; 15 women who had gotten a placebo vaccine were infected.

Dr. Herrero explained some of the study’s limitations: when it began, it was concerned only with cervical cancer, so no men were enrolled. The women were initially tested to make sure they had no cervical infections, but were not tested for throat or anal infections. They gave oral samples only once, so it was not possible to say how many had persistent infections; most people clear HPV infections on their own, so only a tiny fraction lead to cancer. Four years is not long enough to know how many cancers would develop — but finding out for sure would require waiting 20 years or more, and ethical guidelines require that all women in the trial get regular examinations and that any suspicious lesions be destroyed before they turn cancerous. Also, only Cervarix, and not Merck’s similar Gardasil vaccine, was tested.

However, Dr. Herrero said, men would “probably” get the same protection as the women did, because the vaccine produces identical antibody levels in both sexes.

Dr. Posner said the large discrepancy in infection rates between those who got the vaccine and those who got placebo suggested that the data was “very reliable” even though the infections were detected far too early to produce cancers.

“What we don’t know,” he said, “is how long-term the protection is, or if re-vaccination is necessary.”

While cancers caused by smoking or drinking usually occur in the mouth, those caused by oral sex usually occur at the base of the tongue or deep in the folds of tonsillar tissue, and are hard to detect. They are more common among heterosexual men than among women or gay men; experts believe that is because vaginal fluid contains more virus than the surface of the penis.

Dr. Eric J. Moore, a Mayo Clinic surgeon specializing in these cancers, said the study was “very encouraging.”

“But remember,” he added. “It only works if you’re vaccinated prior to contracting the infection. Once you’re 40 and have had multiple sexual partners, it’s not going to help.”

*This news story was resourced by the Oral Cancer Foundation, and vetted for appropriateness and accuracy.